Fresh from Arizona: Denial of Life

January 7, 2011

"Blak Lantern" Henry Richards

To paraphrase Mark Twain “Reports of the failure of my transplant have been
highly exaggerated”

On the December 18th NYT article “Transplants Cut, Arizona is Challenged by Survivors.

Arizona recently terminated all state support for bone marrow transplants to treat leukaemia, liver transplants for patients with Hepatitis C, and lung transplants. To support ending these rare but expensive procedures the legislature relied on “statistics” provided to them by state government, for example, that 13 out of 14 bone transplants recipients were dead. A state sponsored study (probably a literature review of treatment effectiveness) put more nails in the coffin of these procedures when it concluded that such transplants “do not significantly affect the diseases they are intended to cure.” and that lung transplants are not really intended to save lives but are “more palliative that than curative.” The statistics and the conclusions of authoritative state studies provided what seemed like a simple and reasonable utilitarian calculus that supported ending procedures.

Not so fast.  The American Society of Transplant Surgeons (ASTS) has contradicted the pessimistic pseudo-science justifications for making the cuts. ASTS reported that survival rates for marrow transplants in Arizona were better than the national survival rate of 40% (9 of 14 were, in fact, still alive). Also in the real Arizona (not the one the members of the legislature’s death panel thought they lived in) liver transplants have a 80% survival rate after one year and 60% are still living at 5 years post-procedure. The Society also corroborated the patently obvious fact that lung transplants “are life saving, not palliative” (Begging the question of whether palliative procedures should be rejected out of hand because they may be expensive and delivered to those doomed to die anyway.) James Healy, a 25 year old college student who received a transplant in 2009, should have end-capped the discussion, at least as far as was to be limited to the survival issue alone: “I’ve started school again, and I’m getting out and about. I’ve seen other people go through it, and I’ve gone through it. We’re very much alive.”

Dozens of recipients of state transplants are alive and challenging the basis of the state’s decision. Nonetheless, Governor Brewer continues to cite the 13 out of 14 death rate, a kind of grizzly latter-day, politically motivated body-count reminiscent of those of the Viet Nam War era. She insists that the state had “no other choices.” In other words, this was the final solution. From a Becker perspective it’s interesting to observe toxic leadership denying the reality of life in the surviving transplant recipients to support a decision that will be sure to kill those who need the transplants now, or will need them in the future. When performed by fanatical, doctrinaire, and self-serving extremists, the first casualty of budget cuts is, as in war, the truth. Surely, there are at least a few viable alternatives to the decision that was made. What was the dynamic that twisted the facts in this particular direction? More curiously, what are the dynamics that support not listening to people by considering them already dead. The legislature should have considered the case of Anna Tovar. She received a bone marrow transplant in 2001, which her body rejected, and a stem cell transplant in 2002. She is still alive working in that same state legislature and opposing these draconian cuts. Her transplants weren’t paid for in by the state program.  I guess no one is afraid of losing the vote of the constituency comprised of folks who are about to die unless the state opens its purse for something other than prisons and doling out tax breaks.


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